WEDNESDAY, May 19, 2021 (Kaiser News) – In 1993, Dr. David Silber, a dentist currently working in Plano, Texas, was dismissed from his first working dental clinic. It was assigned to a patient for whom another dentist had scheduled an appointment to prepare the crown – a metal or ceramic cap for a broken or decaying tooth. However, Silber found nothing wrong with the tooth, so he sent the patient home.
He was fired later that day. He was told, ‘Never send a patient willing to pay a clinic.’
Even today, Silber said, what happened to him is still happening, that some dentists who don’t believe they are receiving enough insurance compensation – be it private insurance or Medicaid – have discovered ways to boost their bottom line. They pay for products and procedures the patient does not need or recommend higher-cost treatment plans when less expensive options achieve the same.
The pressure is even more acute now since the Covid pandemic cut off traffic in dentists’ offices. But while most dentists are ethical, the practice of more profitable procedures, materials, or devices is not new. In 2013, a Washington dentist wrote in a publication of the American Dental Association about his regret for the “creative diagnosis” pattern. A 2019 study of dental costs found large differences in the prices of certain services. She said that whitening teeth in a dentist’s office, for example, is no more effective than whitening strips one would buy at a drugstore – and it’s at least 10 times more expensive.
But sometimes dentists escalate to outright fraud. A recent article in the Journal of Fraud Insurance of America explained: “Medicaid fraud is the most profitable dental business model in the United States today.”
In fact, the ADA sees a problem. “Hundreds of thousands of dental procedures are being performed safely and effectively on a daily basis,” said Dr. Dave Preble, Vice President of the American Dental Association’s Institute of Practice. But he cited a study from the National Health Care Fraud Association that says between 3% and 10% of the $ 3.6 trillion they spend annually on healthcare is lost to fraud every year. That’s $ 13 billion of the $ 136 billion that Americans spend annually on care for teeth lost due to dental fraud.
Silber said he saw the X-rays of one patient after she saw another dentist and was shocked to learn she had two crowns when she only needed one small filling. She was told that a first crown was necessary to treat decay on a tooth, and that a second crown was necessary to make the first crown fit better. “It only needed one small filling. It should have cost her $ 100 or so,” Silber said. “Instead, the dentist convinced her to replace perfectly good teeth so he could make $ 2,400 from her insurance company.”
Firms’ assimilation of small private practices, private equity purchases, or group practices over the past two decades has brought an increased focus on increasing profits. “The CEO at the summit informs the dentists who work for them what to do, such as the chef telling their team of waiters to pay for the special daily offer,” Silber said. “If the dentist refuses to comply, the door is shown to them.”
Patients undergoing treatment are usually pressed into common dental sequences which is a quadruple gradient: a surgical procedure to clean the teeth along the gum line, usually over the course of three or four visits. While the procedure can be beneficial if the patient has severe gum disease, it can also erode gum tissue that cannot grow again. Dentists can charge between $ 800 and $ 1200 per procedure, while standard cleaning nets only cost them about $ 100.
Dr. Michael Davis, a dentist practicing in Santa Fe, New Mexico, said some dentists are looking for procedures that Medicaid pays the most for. He explained that Medicaid pays three to six times more for steel crowns made of nickel and chromium than standard fillings, so some dentists recommend these more lucrative treatments and surgical interventions for unsuspecting patients. “The fit with pre-fabricated steel crowns is unfavorable and gaps can appear, so unethical dentists target young children who won’t notice the deformation until their permanent teeth appear,” Davis said.
Children who still have their primary teeth are the primary targets of a pulpectomy – removal of the tooth pulp – whether or not they need it.
Unethical dentists also perform abbreviated versions of otherwise covered procedures for the patient, while billing the insurance company for the full amount – a practice known as overcoding.
Miniature implants, for example, can be easily coded. Standard dental implants are an artificial tooth root that dentists attach to stabilize a dental crown or bridge. Dr. David Weinman, a dentist practicing in Buffalo, New York, said the miniature implant, by contrast, looked like a “thumb pin compared to a screw”. In the past, miniature implants were only used to hold dentures in place, but because they are much faster to fit and cost the dentist 60% less than a regular implant, more dentists have been recommending them for a long time. Term solution.
“We in the dental community see a high failure rate when using miniature implants where a regular implant is needed, but that hasn’t stopped some dentists from pushing them to patients who don’t know better,” said Weinman.
Then there are the terrifying stories of dentists who have gotten rotten. In March, the state attorney general filed a lawsuit against Dr. Mohab Rizkallah, a Massachusetts orthodontist, for deliberately keeping his patients in orthodontics for too long medically and for misleading bills for mouth guards. The complaint against him alleges that he ordered his employees to purchase plastic mouth protectors from a discount store despite knowing that they would not fit the patient’s teeth properly. Rizkallah then paid Medicaid $ 75 to $ 85 more than the retail price for each one, and more than $ 1 million was compensated for the mouthguards alone, according to the lawsuit.
Other dental practitioners did a much worse job. After a video clip of Dr. Seth Lockhart, an Alaskan dentist, rides a flying board while performing dental surgery, astonished authorities found he was anesthetizing nearly all of his patients to take advantage of Medicaid’s compensation for general anesthesia. He was sentenced last year to 12 years in prison.
The Texas Dental Board revoked the license of Bethaniel Jefferson, a dentist practicing in Houston, after it was found that she was endangering her patients by administering general anesthesia unnecessarily to take advantage of the same insurance payments. A patient has been left deprived of oxygen for a long time in which the child suffers from severe brain damage.
Dr. Scott Charmole, a dentist from Wisconsin, has been charged with fraud after it was found that he was using his drill to intentionally break patients’ teeth so he could bill the insurance company for crowns instead of fillings. The indictment alleges that he conducted more than $ 2 million in crown proceedings between January 1, 2018 and August 7, 2019 – amounting to more than 80 fraud actions per month.
Weinman said that patients can always look for a second opinion – especially for expensive treatments – and that a dentist who seems hesitant when she says you want a second opinion is troubling. “A dentist who is confident of his abilities will have no problem examining you for a diagnosis or a treatment plan elsewhere,” he said.
Other red flags: Weinman said he’s wary of any dentist who appears to be reading from a text, pushing hard for a treatment plan or refusing to explain treatment options. “There may be many scientifically sound and evidence-based treatment plans available to the patient, and a good dentist is willing to explain your options – even those that may not be profitable,” Weinman said.